This study will obtain information on the issues related to implementing aspects of the Patient-Centered Medical Home (PCMH) within the primary care clinics that are participating in Blue Cross /Blue Shield of Michigan's (BCBSM) Physician Group Incentive Program (PGIP). The BCBSM PGIP program supports PCMH implementation for physicians throughout Michigan, and encourages collaboration and information sharing in order to measure and monitor the quality of care, improve systems of care, and effectively manage patients. As of July 2009, the PGIP program involved 36 participating physician organizations (PO) from across Michigan (one of which is an umbrella organization which provides management and practice transformation support services to over 50 physician organizations), including 7,618 primary care physicians and select specialists who are members of BCBSM's TRUST PPO network and provide care more than 1.7 million PPO members. These participating physicians represent approximately 64 percent of active primary care physicians (internal medicine, family practice, pediatrics, and general practice) and 15 percent of specialty physicians in the TRUST PPO network. This study's specific aims are to: 1) Quantify PGIP member practices'progress toward PCMH goals. a) Evaluate whether PCMH progress is associated with improvement on both cost and quality metrics. b) Use measures of progress to select practices that have made more and less rapid progress toward those goals for Aim 2 below. 2) Investigate how practices have succeeded in PCMH transformation, using combined qualitative and quantitative inquiry to discover the processes and tools that have worked well, the resources that have been important and the key organizational and leadership attributes supporting their success. The proposed study will build on our existing relationships with the physician groups participating in the PGIP program, in collaboration with BCBSM. We will capitalize on the credibility we have established with those organizations and on their strong interest in PCMH implementation to improve care and reduce costs. PUBLIC HEALTH RELEVANCE: This study will evaluate a broad-based collaboration between the largest insurer in Michigan (BCBSM) and physician organizations throughout the state to implement components of the Patient-Centered Medical Home, and will provide valuable lessons for PCMH initiatives throughout the country. Because of the wide range of independent practices of varying structure, demographics, and geographic locations participating in this collaboration, the lessons learned from this study will provide greater external validity for the vast majority of primary care practices than do the experiences of large, integrated health systems with employed physician staff and centralized administrative control. Results from this study could also help primary care teams prepare for their journey toward a fully- functioning PCMH by preparing them in advance for challenges that may arise during PCMH implementation, and having information on how others have overcome those challenges.